House Democrats to Pursue Health Bill Changes

WASHINGTON — House Democratic leaders said Tuesday that they would insist on changes to the Senate health care legislation to make coverage more affordable for middle-class Americans and to tighten control over the insurance industry.

But it remains unclear how much leverage the House will have in negotiations given that Senate Democrats cannot spare a single vote without jeopardizing the bill’s chances. The White House will also have a big role in the final product.

The House speaker, Nancy Pelosi, met Tuesday with her top lieutenants and the three committee chairmen directly responsible for the health care bill, as they prepared for negotiations to begin in earnest this week.

Ms. Pelosi and the majority leader, Representative Steny H. Hoyer of Maryland, also met at the White House with President Obama. The top Senate Democrats, Harry Reid of Nevada and Richard J. Durbin of Illinois, joined the meeting by telephone.

Aides said that the White House would convene meetings of House and Senate staff perhaps as early as Wednesday to begin clearing away some of the easier differences between the bills, with Congressional leaders to meet face-to-face next week.

After the meeting at the Capitol, House Democrats said they would push the Senate to provide more generous subsidies to help moderate-income Americans buy insurance, but expressed willingness to drop the idea of a government-run health plan.

The House bill includes a government-run health insurance plan, or public option, to compete with private insurers. The public option was dropped from the Senate bill after centrist Democrats said they would oppose any measure that included it.

House Democrats said they could live without the public option provided that they had sufficient guarantees that other steps would be taken to increase options for consumers and to tighten the clamp on any abuses by private insurance companies.

Representative Chris Van Hollen, Democrat of Maryland and a member of the House leadership, said some of his colleagues would press to end the insurance industry’s exemption from federal antitrust laws, a step strongly opposed by Senator Ben Nelson, Democrat of Nebraska, who has said he would oppose the bill if the House made any changes that he did not like.

“We understand the realities of what happened in the Senate,” Mr. Van Hollen said. But he said House leaders still found aspects of the Senate bill lacking in terms of providing affordable health coverage to people who are now uninsured.

“We don’t think it achieves enough in the way of competition and choice,” he said.

Even as Democrats made plans to reconcile the bills, Republicans renewed their criticism of the legislation, which they have pledged to fight to the end.

Although Congress routinely reconciles major legislation without formal conference proceedings, Republicans seized on a request by C-Span, the public access television network, to broadcast the closed-door talks between House and Senate Democrats as evidence that Democrats were being less than transparent.

The Democrats, including Ms. Pelosi, dismissed that criticism, noting that Republicans were simply out to kill the legislation. And they noted that the full text of the House bill, for instance, has been posted on the Internet since before it was adopted on Nov. 7.

Ms. Pelosi said she was confident that differences between the two measures would be resolved and that a bill would be sent to Mr. Obama for his signature in relatively short order.

“We will reconcile this legislation in a way that is a AAA rating — affordability for the middle class, accountability for the insurance companies and accessibility to many more people in our country to quality, affordable health care,” Ms. Pelosi said.

To help pay for the bill, the House has proposed an income surtax on individuals earning more than $500,000 and couples earning more than $1 million, while the Senate has proposed an excise tax on high-priced insurance policies and an increase in the Medicare payroll tax for individuals earning more than $200,000 and couples earning more than $250,000.

The House bill would cost slightly more than $1 trillion over 10 years, while the Senate bill would cost $871 billion. In each case, the expense would be more than offset by new taxes and fees and reductions in government spending, particularly on Medicare, so the bill would reduce future federal deficits, according to the Congressional Budget Office.

“We think that we have the fairest approach in our bill,” Ms. Pelosi said. “I always say when it comes to tax policy around here, it’s like a mirror. ‘Mirror, mirror on the wall, who is the fairest of them all?’ The Senate thinks theirs is fairer. We think ours is. We’ll see which mirror cracks.”

And even as Senate Democrats do not have a single vote to spare, House leaders warned that they also had careful counting to do.

“I think the Senate should know that we need 218 votes,” said Representative Charles B. Rangel, Democrat of New York.